Active NPI
Peter Sean Kelleher, MPT
- Physical Therapist
- Sacramento, CA
National Provider Identifier
1205876331
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 30209
- Practice address
- 4700 Northgate Blvd Ste 120
Sacramento, CA 95834-1148 - Phone
- (916) 923-4442
- Fax
- (916) 929-1511
- NPI assigned
- Jun 7, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 30209 | CA | Primary |
Addresses
Primary practice location
4700 Northgate Blvd Ste 120
Sacramento, CA 95834-1148
Mailing address
4700 Northgate Blvd Ste 120
Sacramento, CA 95834-1148
Phone (916) 923-4442
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 30209 | CA | MD | Dental Hygienist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149638400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1240963200000",
"number": "1205876331",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4700 NORTHGATE BLVD STE 120",
"city": "SACRAMENTO",
"state": "CA",
"postal_code": "958341148",
"telephone_number": "916-923-4442",
"fax_number": "916-929-1511"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4700 NORTHGATE BLVD STE 120",
"city": "SACRAMENTO",
"state": "CA",
"postal_code": "958341148",
"telephone_number": "916-923-4442",
"fax_number": "916-929-1511"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLEHER",
"first_name": "PETER",
"middle_name": "SEAN",
"credential": "MPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-07",
"last_updated": "2009-04-29",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "30209",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sacramento, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.